Healthcare Provider Details

I. General information

NPI: 1659943314
Provider Name (Legal Business Name): EMPOWERME REHABILITATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2021
Last Update Date: 12/16/2023
Certification Date: 12/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 WATER TOWER PL
CLARKSTON MI
48346-2668
US

IV. Provider business mailing address

PO BOX 736005
DALLAS TX
75373-6005
US

V. Phone/Fax

Practice location:
  • Phone: 844-502-7996
  • Fax:
Mailing address:
  • Phone: 844-502-7996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN DAVID CHURCH
Title or Position: VICE PRESIDENT OF FINANCE
Credential:
Phone: 618-972-5228